Abstracts

Background: Stress is a well known problem within health care professionals. Various factors lead up to it - e.g. confrontation with illness and death, increasing demands of care for multimorbid and elderly patients, shortage of staff, timing and duration of working hours or fear of losing the job.
Many studies suggest that level of burnout cases among dialysis employees is moderate compared to other nursing groups because there are some advantages in comparison to hospital nursing, including less conflict between work and private life.
However, renal nurses are no exception when it comes to stress but are prone to additional and more specific types. They have to deal with complex dialysis techniques and technology, intense activities during initiation and termination of dialysis sessions, life-threatening complication during tretament or technical breakdown of machines. The chronic relationships with patients and their families and often demanding or even aggressive patients as well as continuous shortage of qualified dialysis nursing staff are major sources of stress.
The literature shows that constant exposure to stressors induces emotional conflict and ambiguity, which results in the use of coping techniques to balance well-being such as frustration, denial and sick leaves.
Ongoing stress can cause exhaustion and burnout and pose serious health problems as well as safety hazards on the job.
Therefore there is a need to better understand the stressors which are individually experienced and develop coping strategies that promote successful coping and minimise burnout.

Background: Decision-making and the accompanying education process about kidney disease treatment options is often complex and unstructured. The Australian shared decision-making tool- ‘My Kidneys, My Choice’ Decision Aid (DA)"- was developed to facilitate this process.Objectives: To determine the patient opinions and experience of the decision-making process supported by the DA.Methods: Design: A multi-site pre-test post-test survey method with Likert-scale questions. Routine education was supported by the DA. Knowledge levels about treatment options, lifestyle priorities and expectations were tested pre and post-education. The post survey also assessed the DA and the preferred treatment choices. SPSS was used for data analysis.Results: Acceptance of the DA (out of 5) was high scoring: 4.21 (SD0.75) writing down treatment choices up to 4.90 (SD0.41) for the use of the treatment option comparison grids. Home dialysis options were the preferred treatments.
Self-reported knowledge levels (out of 4) about treatment options pre-education and decision-making ranged from 0.88 for conservative care to 1.32 for centre-based haemodialysis. Post decision making knowledge levels had increased significantly for all options (p<0.001).
Pre-scores for worry (out of 5) were: about future (4.15, SD1.3), change of lifestyle (4.23, SD1.05) and the ability to work/leisure (3.67, SD1.56). The desire for flexibility score was 4.51, (SD0.86). After decision making there were significant increases in worry: about future (4.61), change of lifestyle (4.59), ability to work (4.27) and desire for flexibility 4.76 (p<0.05).Conclusion/Application to practice: The DA was well accepted by and useful for patients. The high levels of post-education worry may indicate an opportunity to improve support.Disclosure: The development of the decision aid in 2012 was funded by an unrestricted educational grant provided by Baxter Health Care.

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Working close with a patient-education-oriented – patient organization

Background: According to the World Health Organization (WHO), Therapeutic Patient Education (TPE) enables people with chronic diseases to manage their illness and yields benefits in both health and financial terms. Our dialysis unit made a liaison with a platform for out-hospital patient education called “Actifclub” where all activities and resources are organized to increase the quality of life of different chronic patients. It allows integration of the disease and the treatment in everyday life as much as possible throughout the therapeutic career of each individual. This is part of a quality dynamic in the treatment of patients and allows teams to be motivated based on a multidisciplinary project.Objectives: The common goal is to develop a “Culture of TE” for “carers” and “cared for”.Methods: Educational Project against passivity, depression and burnout.
Use events to increase communication between “carers” and “cared for”
Create opportunities to meet and work together: “carer” and “cared for” in order to increase the skills of negotiation among all and build a common culture of TE.
Promote and strengthen resource mobilization and project implementation by all at individual level, patient group level and at the level of movement due to a systemic work.
Together we organized a one-day museum-visit and a midweek stay in a bison farm in the Belgian Ardennes with a group of patients and created intentionally a lot of informal interactions.Conclusion/Application to practice: “Informal” did the trick to “educate”
Language and cultural barriers not as insurmountable as thought
Patient knowledge on treatment compliance seem to improve

Background: Patients with CVC lines require significant education concerning their care and management to avoid complications associated with blood stream infections (BSI). The current dialysis facility provides dialysis to the north, south and Western region of Saudi Arabia. Increasing numbers of patients arriving for dialysis with wet, soiled and contaminated CVC dressings triggered an urgent review of patient education.Objectives: To review, revise and re-design patient education concerning CVC catheter care at home. To reduce the incidence of exit site infection and blood stream infections.Methods: A collaborative practice project involving nurses, infection control nurses and physicians employing Focus PDCA methodology. Re-design of a patient education program with targeted interventions from the infection control team. Data collection included CVC exit site infections and hospital admission rates due to BSI. Enhanced patient education by primary nurse and dedicated Arabic speaking nurse to educate patients and family members.Results: Data were collected using Centre for Disease Control National Healthcare Safety Network (NSHN) benchmark for central line infection which was 4.2 per 1000 patient treatments – within dialysis units this is now 0.9. Patients with wet and open dressings reduced from 40 to 5, with admissions to hospital due to BSI dropped to zero. Extensive surveillance for BSI, monitoring and hand hygiene audits were implemented.Conclusion/Application to practice: Focus PDCA facilitated a truly multi-disciplinary approach to a serious life threatening event for dialysis patients. The complete redesign of patient education using culturally appropriate materials delivered by Arabic speaking nurse has played an important role in the success of the project.

Background: A recent training needs analysis combined with observation when working 1:1 with staff highlighted that nurses were not confident in their critical thinking skills which impacted on their confidence to challenge decisions made by medical staff and senior nurses. A pilot of Action Learning Sets (ALS) was established as a form of group clinical supervision to determine their usefulness/benefits in professional development.Objectives: To determine if clinical supervision in the form of ALS was perceived by the participants as beneficial in relation to professional development; especially to critical thinking skills, reflective practice, challenging decisions and problem solving.Methods: The participants of two Action Learning Sets voluntarily consented to participate in this qualitative study. A questionnaire was sent to the participants using SurveyMonkey TM and all responses were submitted anonymously. A mix of Likert scale and free text questions were asked to determine previous experience of ALS, understanding of reflective practice and critical thinking. The free text questions called for short reflections on the impact of ALS on practice.Results: The response rate was 88%, 50% of staff had prior exposure to ALS. 87% felt ALS had developed their capacity for reflective practise and had had a positive impact on their clinical practise with >85% feeling more confident in their role. All respondees recommended the extension of ALS to charge and staff nurses and 75% expressed the desire to facilitate a group.Conclusion/Application to practice: ALS has been seen as a very positive tool and there is a desire to expand the programme across the organisation.